FOLFOX4联合参麦注射液治疗中晚期肝癌术后存活质量的影响

目的探究FOLFOX4联合参麦注射液治疗中晚期肝癌术后存活质量的影响。方法选取2012年3月~2014年2月我院收治的90例原发性肝癌患者为研究对象,按随机数字表法分为观察组和对照组,每组45例,对照组患者单独给予FOLFOX4方案(奥沙利铂~+亚叶酸钙~+5-氟尿嘧啶)治疗,观察组在对照组基础上联合参麦注射液,治疗2个疗程后评价两组患者治疗疗效,同时分别检测治疗前后患者血液T淋巴细胞亚群(CD3~+、CD4~+、CD8~+)变化情况,比较两组患者治疗前后细胞免疫指标。观察两组患者治疗前后生存质量评分和KPS评分改善程度和毒副反应。结果观察组患者治疗总有效率为57.78%,对照组患者治疗总有效率为35.56%,两组差异具有统计学意义(P0.05)。治疗后两组患者CD3~+、CD4~+、CD8~+、CD4~+/CD8~+细胞免疫指标差异显著,观察组患者CD3~+、CD4~+、CD4~+/CD8~+细胞免疫指标明显明显高于对照组,CD8~+指标明显低于对照组,差异具有统计学意义(P0.05)。治疗后两组患者生活质量评分和KPS评分总改善率差异显著,观察组生活质量评分和KPS评分总改善率显著高于对照组,差异具有统计学意(P0.05)。两组患者在骨髓抑制、神经毒性、肝功能方面等毒副反应差异具有统计学意义(P0.05),而在胃肠道反应、口腔炎上差异不具有统计学意义(P0.05)。结论参麦注射液联合FOLFFOX4方案治疗中晚期原发性肝癌具有良好疗效,能够改善患者免疫力和提高患者生活质量,降低化疗引起的毒副反应,其疗效明显优于单独FOLFFOX4方案治疗。     

FTY720 and everolimus in de novo renal transplant patients at risk for delayed graft function: results of an exploratory one-yr multicenter study

Abstract:  This exploratory, multicenter, open-label study evaluated the efficacy and safety of FTY720, as a part of an immunosuppressive regimen, in combination with everolimus and steroids in de novo renal transplant recipients at increased risk of delayed graft function (DGF). Patients received FTY720 (5 mg) and everolimus (4 mg) 2–12 h pre-transplantation, followed by 2.5 mg/d FTY720 and concentration-controlled everolimus (4–8 ng/mL) post-transplant for 12 months. Induction therapy was prohibited. After enrollment of 56 of the planned 200 patients between 2000 and 2002, the recruitment was terminated. The primary endpoint, rate of graft loss, or death at three months was 15.4% and the biopsy-confirmed acute rejection was 42.3%. Death or graft loss at 12 months in the DGF and non-DGF arms was 36.0% and 25.9%, respectively. The mean estimated creatinine clearance at three months was 63 and 55 mL/min in the non-DGF and DGF groups, respectively, while at 12 months it was 56 mL/min in both the groups. Although there was no comparator arm, the results from this exploratory study (compared with data from other phases II and III trials) indicated no apparent benefits of FTY720-based regimens for prevention of acute rejection and preservation of renal function in renal transplant recipients at high risk of DGF.     

高压氧个体化治疗方案实施探讨

目的：探讨个体化高压氧治疗方案的临床应用与疗效。方法：A组3200名患者根据其年龄、病种、病情、心理状况结合氧舱内治疗生命体征监护数据,选择不同的个体化治疗方案：1、方案A,从0．1ATA治疗压力逐渐增加至0．2ATA的渐进式治疗;2、方案B,重症病人单独开舱治疗;3、方案C,脑出血、脑血管瘤术后等特殊病种采用升、减压速率相对慢、1．75ATA压力治疗;4、方案D,新生儿、小婴儿和高龄老年人按年龄选择治疗压力1．3ATA～1.6ATA、升、减压速率3～4kPa／min、吸氧40～60分钟治疗;5、方案E．升、减压速率5 kPa／min,2．0ATA稳压吸氧60分钟传统常规治疗。另以未采用个体化治疗方案前使用传统常规治疗方案的1820名为对照B组。观察两组病人治愈率、治疗总有效率和对医嘱的依从性,治疗安全性。结果：A组病人疗效和治愈率均优于B组（P〈0．01）;与B组比较, A组昏述和气管切开病人比例增加2．19％、婴幼儿增加6．22％、≥170岁高龄老年人增加7．44％,P均〈0．01,而且在治疗过程中均未出现不良病情变化;实施个体化治疗方案后愿意接受高压氧治疗的病人从原先的64．52％增加到77．63％,差异有统计学意义。结论：根据不同的病人、病种、病情采用不同的个体化治疗方案进行高压氧治疗,可明显提高治疗效果、医嘱依从性和治疗安全性,是更为科学合理和人性化的高压氧治疗方法。     

GP与TP方案治疗NP方案化疗失败的非小细胞肺癌的疗效比较

目的 探讨NP方案化疗后进展的晚期非小细胞肺癌（NSCLC）应用GP和TP方案的疗效和毒性。方法 总结65例NSCLC患者均曾接受过NP方案化疗2周期，出现病情进展后所接受的化疗方案分成GP组和TP组，每例患者至少接受2个周期以上的同一方案治疗，比较两组方案治疗的效果和不良反应。结果 GP组和TP组的总有效率分别为19．35％、8．82％，两组间比较差异有显著性（P〈0．05）；1年生存率分别为22．58％、20．59％，2年生存率分别为6．45％、5．88％，GP组和TP组患者的中位生存期分别为8．1个月和7．9个月，两组间比较差异无显著性（P〉0．05）。GP组和TP组的不良反应均在可耐受范围。结论 GP方案和TP方案对NP方案化疗失败的晚期NSCLC有一定疗效，但有效率较低，GP方案较TP方案近期有效率高，中位生存期、年生存率比较差异无显著性（P〉0．05）。     

地榆升白片预防含泰素方案化疗患者白细胞减少症的临床观察

目的观察地榆升白片预防含泰素方案化疗患者白细胞减少症的疗效。方法使用含泰素方案化疗的恶性肿瘤患者69例,治疗组32例,化疗同时服用地榆升白片,并与单纯化疗的37例作对照,观察两组的外周血白细胞数的变化、粒细胞集落刺激因子（G-CSF）的用量及继发感染发生情况等。结果治疗组化疗后Ⅲ度以上白细胞减少发生率低于对照组,差异有显著意义。治疗组在化疗第14天、21天的白细胞数均高于对照组,二者差异有显著性。两组集落刺激因子用量、白细胞减少继发感染发生例数之间的差异均有统计学意义。结论地榆升白片能有效预防含泰素方案化疗患者白细胞减少症。     

不同给药方案喙突下臂丛麻醉效果比较

目的：比较不同给药方案上肢手术喙突下臂丛麻醉的效果。方法：喙突下臂丛麻醉患者64例,随机分为3组,3种方案给药,方案①20例1％利多卡因30ml;方案②24例1％利多卡因20ml＋0.25％布比卡因10ml;方案③20例1％利多卡因10ml＋0.25％布比卡因20ml。测定麻醉起效时间、完善时间、持续时间及运动阻滞程度。监测药物不良反应。结果：3组麻醉结果,优良率皆达100％,起效时间、完善时间方案②及③皆长于方案①;持续时间方案②及③皆较方案①明显延长,各为其2.8倍及5倍,3组皆无不良反应。结论：3种方案皆安全有效。方案①麻醉起效快、短;方案②及③起效稍慢但持久。为临床不同时间手术选择不同给药方案提供了依据。     

Modified conditioning regimen busulfan-cyclophosphamide followed by allogeneic stem cell transplantation in patients with multiple myeloma

Background Allogeneic stem cell transplantation is a potential curative approach in patients with multiple myeloma. The very high transplant related mortality associated with standard allogeneic stem cell transplantation is currently the major limitation to wider use of this potentially curative treatment modality. The challenge for clinical investigators is to reduce the incidence of post-transplant complications for patients receiving autologous hematopoietic stem cell transplantion for multiple myeloma. In this study the toxicity and efficacy of modified myeloablative conditioning regimen followed by allogeneic stem cell transplantation was investigated in patients with multiple myeloma. Methods The conditioning regimen consisted of hydroxyurea, cytarabine, busulfan, cyclophosphamide, and semustine. Ten patients underwent allogeneic transplantation among them hydroxyurea （40 mg/kg） was administered twice on day -10 and cytarabine （2 g/ms） was given on day -9, busulfan was administered orally in four divided doses daily for 3 days （days -8 to -6）. The dose of busulfan was 12 mg/kg in the protocol followed by cyclophosphamide intravenously over 1 hour on days -5 and -4 （1.8 g/m^2）, and with semustine （Me-CCNU） 250 mg/m^2 on day -3. Results Chimerism data were available on all patients and all patients achieved full donor chimerism without graft failure. Six patients had not acute graft-versus-host disease （GVHD, 36.4%; 95% CI： 13.9%-38.6%）. Two patients （18.2%） developed grade Ⅰ acute GVHD （95% CI： 10.9%-35.9%） and grade Ⅱ acute GVHD occurred in one patient （9.1%; 95% Cl. 8.4%-32.3%）. Severe grade IVa GVHD was seen in one patient, who died from acute GVHD. The incidence of chronic GVHD was 22.2% （95% Cl： 11.7%-36.7%）, among them one died of severe grade IV GVHD and one developed multiorgan failure on day ＋170; the treatment-related mortality was 22.0% （95% Cl： 10.3%-34.1%）. The overall 4-year survival rate was 67.8% （95% Cl： 16.3%-46.7%）. The estimated 4-year progression-free survival rate was 58.5% （95% CI： 13.7%-41.8%）. The 4-year complete remission was 72.7% （95% CI： 27.8%-49.6%）. One patient relapsed after 4 months and achived the complete remission after receiving the donor lymphocyte infusion. Conclusions Modified conditioning regimen busulfan-cyclophosphamide with peripheral blood stem cells＋bone marrow cells transplantation result in a low incidence of severe GVHD with a relatively low treatment-related mortality, high complete remission rates and a long-term survival.     

CAG治疗急性巨核细胞白血病变为首发的慢性粒细胞白血病(首例报道及文献复习)

目的 探讨慢性粒细胞白血病急性巨核细胞白血病变后的表现和治疗方法.方法 报道1例以急性巨核细胞白血病为首发表现的慢性粒细胞白血病(CML),先后予以CAG方案和伊马替尼治疗.结果 该患者获得血液学及分子生物学缓解,且耐受良好.结论 极少数CML患者以急性巨核细胞白血病为首发表现,CAG方案、伊马替尼有较好疗效.     

不同化疗方案对初始诱导失败急性髓性白血病患者近期疗效、生存期及不良反应的影响

目的 探讨不同化疗方案对初始诱导失败急性髓性白血病（acute myeloid leukemia,AML）患者近期疗效、生存期及不良反应的影响。方法 回顾性纳入2017年1月～2019年12月华北石油管理局总医院收治的120例初始诱导失败AML患者,按照治疗方案的不同分为FLAG方案[氟达拉滨（fludarabine,Flud）联合阿糖胞苷（cytarabine,Ara-C）及粒细胞集落刺激因子（granulocyte colony stimulating factor,G-CSF）]组、CAG方案[阿柔比星（aclarubicin,Acla）联合Ara-C及G-CSF]组及MAC方案[米托蒽醌（mitoxantrone,MTZ）联合环磷酰胺（cyclophosphamide,CTX）及Ara-C]组,每组40例。比较3组的近期疗效、生存期及不良反应。结果MAC方案组的完全缓解率（complete response,CR）明显高于FLAG方案组及CAG方案组（52.50%vs. 32.50%、35.00%,P<0.05）,总缓解率（overall response rate,OR...